Long-term occlusion results with SILK flow diversion in 28 aneurysms: Do recanalizations occur during follow-up?

Abstract

<jats:sec><jats:title>Background and purpose</jats:title><jats:p> The purpose of this article is to report on the long-term success rates of Silk flow-diverter (FD) treatment in a multicenter prospective study for the treatment of complex aneurysms. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Between May 2008 and January 2011, all consecutive patients featuring complex intracranial aneurysms eligible for FD treatment with the Silk in three neurovascular centers were included. Clinical and imaging data were assessed during hospitalization and follow-up. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Five patients were initially asymptomatic, 20 patients showed various neurological symptoms. Twenty-eight FDs were implanted in 25 patients treating 28 aneurysms. The immediate procedure-related morbidity was 8% (two of 25), mortality 0%. One procedure-related death was observed during follow-up (in-stent thrombosis). Compared to the immediate result nearly two of three aneurysms improved during follow-up; all angiographically confirmed inflow changes took place within six months after treatment. Final anatomic outcome in 24 aneurysms of 22 patients comprised 14 (59%) with complete occlusion, seven (29%) with a neck remnant, two (8%) with residual filling &lt;50%, none with residual filling &gt;50% and one (4%) unchanged in comparison to its pretreatment status. Postinterventional recanalizations were seen in three of 13 (23%) aneurysms treated with FD alone; none were observed in 15 aneurysms treated with adjunctive coiling. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Anatomic presentation and location are key for successful FD treatment. The rate of successful occlusion increases during follow-up. Postinterventional monitoring for at least six months is paramount, as anatomic outcome is not reliably predictable and recanalizations may occur in initially completely occluded aneurysms. </jats:p></jats:sec>

Endovascular Treatment of Anterior Circulation Aneurysms With the p64 Flow Modulation Device: Mid- and Long-Term Results in 617 Aneurysms From a Single Center

“…Recurrence of a totally occluded aneurysm after FDS is a rare but possible finding. 20 In our case, a lenticulostriate artery was running off the aneurysm, which could explain the recurrent filling, as suggested by Trivelato et al 21 …”

Evaluation of flow changes after telescopic stenting of a giant fusiform aneurysm of the vertebrobasilar junction

“…A flow-diverter is a highly braided stent aimed to recover a natural blood flow in the cerebral artery and initiate aneurysm thrombosis [11]. Since the appearance in clinical practice in 2007, flow-diverter stents became a useful tool for treating complex, wide-necked aneurysms, which could not be treated with traditional clinical methods such as coiling and clipping [12, 13]. Several multicenter long-term studies reported a high occlusion rate and low risk of complications during the follow-up, although for some specific cases, especially for giant fusiform aneurysms, the complication rate is much higher [14, 15].…”

The Silk flow-diverter stent for endovascular treatment of intracranial aneurysms

“…In Mpotsaris et al [66] single center series of 25 patients with 28 IAs treated with SFD, the rate of complete occlusion and neck remnant was 59 and 29%, respectively. In subgroups analysis (SFD alone vs adjunctive coiling), the rate of recanalization was 23% in 13 IAs treated with SFD alone and no recanalization was observed in 15 IAs treated with SFD and coiling.…”